The patella is an important component of the knee extension structure. The anterior aspect of the femoral talus and the posterior articular surface of the patella constitute the patellofemoral joint. The patellofemoral joint has the thickest cartilage in the human body, with a maximum thickness of 7 mm. The changing characteristics of the cartilage thickness of the articular surface help to enhance the fit of the patellofemoral articular surface. During knee extension and flexion, the contact area between the patellofemoral joint is a dynamic process. At full knee extension, there is separation between the patellofemoral articular surfaces. From 15° of knee flexion, the lateral patellofemoral articular surfaces are in contact first, and the medial articular surfaces do not begin to contact until 30°-40° of knee flexion. During knee flexion at less than 90° the contact surfaces move from distal to proximal, at 90° the contact surfaces are mainly concentrated at the superior pole of the patellofemoral articular surface and at greater than 90° the contact surfaces return to the middle of the patellofemoral articular surface and are separated on both sides. When the knee is flexed beyond 120°, only the small articular surface of the medial patella remains in contact with the medial femoral condyle. In addition, the contact between the quadriceps tendon and the femoral condylar glide occurs at 90° of knee flexion, i.e., “tendon-femoral contact,” and the contact area increases as the knee flexion angle increases. In conclusion: the patella is very complex during knee flexion and extension: the summary is that the patellofemoral joint has typical three-dimensional motion characteristics. During extension to flexion of the knee joint, the patella slides downward from the beginning of the supracondylar fossa of the femur, accompanied by the phenomenon of the patella moving and tilting medially on the way. (The above paragraph may seem boring and uninformative to patients. You just need to know that the patella is more complex and important than you can imagine, and the knee function will definitely be affected if the patella is not moving well. (From now on, pay attention to the part of the knee exercises about patellar luxation, and you’ll be fine!) After knee adhesions, a series of physiological and biochemical changes in biomechanics and tissue structure occur, and patellar mobility decreases significantly. This disrupts the balance of the extension and flexion moments, losing the mechanical transmission and the role of the lever fulcrum, causing the extension and flexion of the knee function, especially for the flexion of the knee. Therefore, patellar luxation is a top priority when restoring knee mobility! Improving patellofemoral mobility is of great importance to improve joint mobility in patients after knee adhesions, or adhesion releases. In particular, it has an important role in restoring the active mobility of the patient’s knee (AROM) and is an important part of the rehabilitation of knee adhesions. This is my own modification of the classic patellar release: “Dynamic patellar release in flexed knee position” In clinical practice, we find that the decrease in patellar mobility is most pronounced in the upward direction. Simply put, it is easier to push the patella inward and outward, and it is okay to push it downward (toward the calf), but it is very difficult or impossible to push it upward (toward the thigh). This is because the quadriceps is more flexible compared to the patellar tendon, which is easier to pull loose during the exercise; at the same time, the soft tissue in the patellar tendon area is more likely to form scarring and adhesions, which will “pull” the patella and limit its upward sliding. At this point, we can use patellar release in the flexed knee position, with a small range of knee flexion and extension, to perform dynamic release. The contracted patellar tendon can be better retracted. Of course, this operation varies from person to person and needs to be used in conjunction with the patient’s condition, and it is more difficult to perform and more demanding for the therapist. Overall, patellar release requires slow, forceful movements, holding it at the limit of movement for about 10 seconds, fully stretching it and then relaxing it. Do not push quickly and repeatedly. About 10 times in each direction should not be excessive. The angle of flexion and extension of the knee in the seated position, and the warm-up before the knee flexion and extension muscle exercises, are facilitative and of great importance. At the same time, attention must be paid to the direction of force application, trying to avoid excessive downward pressure on the patella when pushing the patella. In this way, while pushing the patella, compressing the patella in the skid will wear the articular cartilage, similar to doing the “patella grinding test”, which will cause new injuries and is not conducive to functional recovery. Therefore, the seemingly simple patellar release technique is of great significance to patients with knee problems. It is equally important for the rehabilitation therapist who performs the technique!